Abstract
The decision to prescribe neuroleptics for the treatment of psychosis involves a potentially tragic choice between, on the one hand, a probability of psychosis and a probability of side effects, such as tardive dyskinesia, on the other. In an experimental paradigm, we examined this decision process. We hypothesized that linguistic factors considered irrelevant under classical formulations of individual choice behavior would have a significant effect on this decision. All subjects were presented with a case vignette involving a potentially psychotic patient. Subjects were then asked what probability of tardive dyskinesia they would either “accept” or “risk” in order to prevent psychotic decompensation. In addition this factor was crossed with a contextual factor that varied the patient's age. The effect of “risk” versus “accept” language was evident in significantly different patterns of decision making across age groups. The data have important implications for clinical decision making, the elicitation of informed consent, and the directions that the courts have taken in malpractice and patient's rights cases.
Footnotes
-
Drs. Bursztajn and Gutheil are affiliated with the Program in Psychiatry and the Law, Massachusetts Mental Health Center, 74 Fenwood Road, Boston, MA 02115. Dr. Chanowitz is affiliated with the Department of Psychology and the Graduate Center, Brooklyn College, C.U.N.Y., New York, NY. Dr. Hamm is affiliated with the Center for Research on Judgment and Policy, University of Colorado, Boulder, CO. The authors wish to thank Prof. Miriam Schustack of the Department of Psychology and Social Relations, Harvard University, for helpful suggestions in the design of this study. This paper was presented at Society for Medical Decision Making meetings, November 1983, Toronto. Abstract published in: Medical Decision Making Vol. 3, p. 539, 1983.
- Copyright © 1991, The American Academy of Psychiatry and the Law
